IN this propensity score matched analysis of 667 patients with resectable esophageal squamous cell carcinoma after neoadjuvant therapy, researchers compared robot assisted minimally invasive, conventional minimally invasive, and open esophagectomy. Key outcomes included total and regional lymph node yield, postoperative complications, length of stay, overall survival, and disease-free survival.
Robotic Minimally Invasive Esophagectomy After Neoadjuvant Therapy
Robot assisted minimally invasive esophagectomy achieved the highest total lymph node yield. Median counts reached 45.4 nodes compared with 36.3 for minimally invasive esophagectomy and 30.1 for open esophagectomy. Gains were most marked in challenging regions such as the upper mediastinum, subcarinal area, cervical field, and perigastric stations, which are critical for thorough oncologic clearance in esophageal cancer.
Lymph Node Yield and Nerve Injury Outcomes
Despite more extensive lymphadenectomy, safety outcomes with robotic minimally invasive esophagectomy were favorable. Rates of recurrent laryngeal nerve palsy were 8.9 percent with the robotic approach compared with 26.8% with minimally invasive esophagectomy and 28.6% with open esophagectomy. Hospital stay was also shorter after the robotic procedure, at nine days versus twelve days for minimally invasive esophagectomy and fifteen days for open surgery. Most other postoperative outcomes were similar across the three groups, suggesting that the gains in nodal clearance did not come at the cost of excess morbidity.
Survival Signals Favor Minimally Invasive Techniques
Both forms of minimally invasive surgery were associated with better overall survival and disease-free survival than open esophagectomy. Hazard ratios for death and recurrence ranged from 0.39 to 0.46 for the minimally invasive approaches compared with open surgery, with no meaningful difference between the robotic and non-robotic techniques. Exploratory subgroup analyses indicated that the survival advantages of minimally invasive esophagectomy were more apparent for upper and middle esophageal tumors.
Clinical Implications for Esophageal Cancer Surgery
For centers managing patients with esophageal squamous cell carcinoma after neoadjuvant therapy, these findings support wider adoption of robotic surgery where expertise and resources are available, while reinforcing the value of conventional minimally invasive approaches. The data suggest that both minimally invasive strategies can provide more extensive lymph node dissection, lower rates of recurrent laryngeal nerve injury, and shorter hospital stays than open esophagectomy, together with signals of improved survival, particularly for upper and middle tumors.
Reference: Hong J et al. Surgical Outcomes of Robotic, Minimally Invasive, and Open Esophagectomy After Neoadjuvant Therapy: a Propensity Score Matching Study. Ann Surg Oncol. 2025;doi:10.1245/s10434-025-18809-1.
